Provider Demographics
NPI:1326180134
Name:MRUTHYUNJAYA, BASAPPA (DDS)
Entity Type:Individual
Prefix:DR
First Name:BASAPPA
Middle Name:
Last Name:MRUTHYUNJAYA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14539 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6065
Mailing Address - Country:US
Mailing Address - Phone:352-596-1938
Mailing Address - Fax:352-596-1943
Practice Address - Street 1:14539 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6065
Practice Address - Country:US
Practice Address - Phone:352-596-1938
Practice Address - Fax:352-596-1943
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN8232122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist